清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后

doi:10.20223/j.cnki.1000-8535.2025.03.015

摘要/Abstract

摘要： 目的探讨清醒镇静应用在急性缺血性脑卒中血管内治疗中的效果。方法选择2020年1月—2023年3月医院接收的急性缺血性脑卒中患者82例进行研究,按随机数表法分为2组,每组各41例,两组采取溶栓与取栓治疗,对照组采取全身麻醉方式,观察组采取清醒镇静方式,记录两组治疗相关参数,比较两组近期疗效、并发症发生情况及预后。结果观察组入院到腹股沟穿刺时间（95.52±3.63）min、穿刺至血管再通时间（72.25±5.58）min低于对照组（112.25±4.18）min、（102.45±10.63）min（t=19.349,P<0.05）;观察组ICU时间（7.81±2.63）d、住院时间（13.75±3.64）d,与对照组（8.05±2.81）d、（14.52±4.07）d比较差异无统计学意义（t分别为0.524、0.399、0.902,P分别为0.601、0.690、0.369）。观察组近期总有效39例（95.12%）与对照组37例（90.24%）比较差异无统计学意义（χ²=0.719,P=0.396）。观察组症状性颅内出血3例（7.32%）与对照组6例（14.63%）比较差异无统计学意义（χ²=1.123,P=0.289）;观察组脑水肿4例（9.76%）、坠积性肺炎12例（29.27%）,低于对照组7例（17.07%）、18例（43.90%）（χ²分别为4.969、6.962,P分别为0.025、0.008）。观察组预后良好21例（51.22%）高于对照组10例（24.39%）（χ²=6.275,P=0.012）。结论急性缺血性脑卒中患者溶栓与取栓治疗中采取清醒镇静方式可获得与全身麻醉相近的疗效,而且可进一步缩短治疗时间,促进血管快速再通,减少相关并发症,使患者获得更好的预后。

关键词: 缺血性脑卒中, 清醒镇静, 溶栓, 取栓, 并发症, 预后

Abstract: Objective To investigate the conscious sedation effect of endovascular treatment in acute ischemic stroke．Methods A total of 82 patients with acute ischemic stroke admitted to the hospital from January 2020 to March 2023 were selected and divided into two groups according to the random number table method,with 41 cases in each group．The two groups were treated with thrombolysis and thrombectomy,the control group was treated with general anesthesia,and the observation group was treated with conscious sedation．The short-term efficacy,complications and prognosis were compared between the two groups．Results The time from admission to groin puncture [（95.52±3.63）min] and time from puncture to vascular recanalization [（72.25±5.58）min] in the observation group were significantly lower than those in the control group [（112.25±4.18）min,（102.45±10.63）min]（t=19.349,P<0.05）．Observation group ICU time,length of hospital stay（7.81+2.63）d（13.75+3.64）d,and the control group（8.05+2.81）d,（14.52-4.07）d had no statistically significant difference in comparison（t were 0.524,0.399,0.902,P were 0.601,0.690,0.369）．Recent total effective cases observation in group was 39（95.12%）and control group was 37（90.24%）,there was no statistically significant difference comparing（χ²=0.719,P=0.396）．Observation group had symptomatic intracranial hemorrhage in three patients（7.32%）and control group had six cases（14.63%）,there was no statistically significant difference（χ²=1.123,P=0.289）．There were four cases（9.76%）of brain edema and 12 cases（29.27%）of hypostatic pneumonia in the observation group,which were significantly lower than seven cases（17.07%）and 18 cases（43.90%）in the control group（χ²=4.969,6.962,P=0.025,0.008）．The number of patients with good prognosis in the observation group（21 cases,51.22%）was significantly higher than that in the control group（10 cases,24.39%）（χ²=6.275,P=0.012）．Conclusions In the treatment of acute ischemic stroke patients with thrombolysis and thrombectomy,conscious sedation can achieve the same efficacy as general anesthesia,and can further shorten the treatment time,promote rapid recanalization of blood vessels and reduce related complications,so that patients can get a better prognosis．

Key words: ischemic stroke, conscious sedation, thrombolysis, thrombectomy, complications, prognosis

刘文政, 金明杰, 张宁, 刘金强, 常乐. 清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后[J]. 广州医药, 2025, 56(3): 382-386.

LIU Wenzheng, JIN Mingjie, ZHANG Ning, LIU Jinqiang, CHANG Le. Effect of conscious sedation in the application of endovascular treatment and prognosis of acute ischemic stroke[J]. Guangzhou Medical Journal, 2025, 56(3): 382-386.

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